Methods for Repairing Craniomaxillofacial Bones Using Customized Bone Plate

ABSTRACT

Bone plates and methods of using the bone plates for adjoining bone fragments are disclosed herein. A device for adjoining at least two bone fragments includes a delivery catheter having an elongated shaft with a proximal end, a distal end, and a longitudinal axis therebetween, wherein the delivery catheter has an inner void for passage of at least one filling material and an inner lumen for passage of a light source; a conformable bone plate releasably engaging the distal end of the delivery catheter, wherein the conformable bone plate has a first surface, a second surface, a proximal end, and a distal end and at least one aperture extending from the first surface to the second surface for receiving a fastener; and an adapter releasably engaging the proximal end of the delivery catheter for receiving the light source and a delivery system housing the at least one filling material.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.13/772,947, filed Feb. 21, 2013, which is a continuation of U.S.application Ser. No. 11/964,370, filed on Dec. 26, 2007, now U.S. Pat.No. 8,403,968, the entirety of these applications are herebyincorporated herein by reference.

FIELD

The embodiments disclosed herein relate to medical devices for use inadjoining bone fragments, and more particularly to conformable boneplates for repair of craniomaxillofacial bony defects and methods ofusing conformable bone plates.

BACKGROUND

Maxillofacial and craniofacial injuries encompass any injury to themouth, face and jaw. Common serious injury to the face occurs when bonesare broken (a fracture). Fractures can involve the lower jaw, upper jaw,palate, cheekbones, eye sockets and combinations of these bones. Thefracture needs to be held in the correct position while the bone ishealing. In most cases this requires fixing the bones using metal orbiodegradable plates and screws, known as internal fixation.

There are a variety of micro, mini and reconstruction plating systems.One of the most commonly used plating system developed to date is theLuhr system manufactured by Howmedica, Inc. Subsequently, based on theoriginal concept by Luhr, several complete systems have been developedfor use in all the various situations encountered in trauma andreconstructive surgery of the facial skeleton. Techniques and materialsused for the internal fixation of the maxillofacial skeleton continue toevolve and improve. For example, metal plates have been used for therepair of craniomaxillofacial bone fractures. These metal plates aregenerally secured to the fractured bone portions with fasteners such asscrews. The plates conventionally employed generally comprise small,generally flat, elongated sections of metal. The sections contain roundscrew holes at various points along their lengths for fastening thesections to bone. The metal plate is then bent into shape and secured tothe fractured bone using a plurality of fasteners seated within thescrew holes. While known systems utilizing plates and fasteners foraiding the osteosynthesis of severed bone regions have proven to beacceptable for certain applications, such systems are neverthelesssusceptible to improvements that may enhance their performance. Forexample, metals are difficult to shape and are hampered by disadvantagessuch as infection and corrosion. Several resorbable plate and screwfixation systems are now available for use in the maxillofacialskeleton. These systems allow initial stable fixation of bone segmentsduring the bone-healing phase and then gradually are reabsorbed throughphysiologic processes.

Regardless of the plate system used, the plate must be contoured to laypassively against the underlying bone surfaces. Therefore, even thoughthe plating systems themselves are manufactured with extremely precisetolerances, an element of imprecision remains for surgeons who repairfacial fractures and do orthognathic surgery or reconstructiveprocedures repositioning the facial skeletal structures to improveesthetics or function. When an osteotomy, fracture, or bone graft isplaced into appropriate position, the bone plate has to be manually bentto the contour of the anatomy. This manual manipulation creates asubstantial element of imprecision even with the use of templates.Maladapted bone plates lead to inappropriate bone contour, irritation ofthe overlying soft tissues, abnormal anatomy or contour defects andeither non-union, malunion or unaesthetic results.

Thus, there is a need in the art for devices and methods for repairingmaxillofacial and craniofacial bony defects that are easy to use,biocompatible, require minimal manipulation once in place, and arecustomizable on a patient-by-patient basis.

SUMMARY

Conformable bone plates and methods for using the bone plates to adjoinbone fragments are disclosed herein. According to aspects illustratedherein, there is provided a bone plate for adjoining at least two bonefragments that includes a flexible pad capable of expanding, the padhaving a first surface and a second surface; and at least one aperturefor receiving a fastener, the at least one aperture extending from thefirst surface to the second surface, wherein the bone plate is able tomove from a first compact position to a second expanded position and iscontoured to passively engage against the at least two bone fragments.

According to aspects illustrated herein, there is provided a device foradjoining at least two bone fragments that includes a delivery catheterhaving an elongated shaft with a proximal end, a distal end, and alongitudinal axis therebetween, wherein the delivery catheter has aninner void for passage of at least one filling material and an innerlumen for passage of light from a light source; a conformable bone platereleasably engaging the distal end of the delivery catheter, wherein theconformable bone plate has a first surface, a second surface, a proximalend, and a distal end and at least one aperture extending from the firstsurface to the second surface for receiving a fastener; and an adapterreleasably engaging the proximal end of the delivery catheter forreceiving light from the light source and a delivery system housing theat least one filling material.

According to aspects illustrated herein, there is provided a method foradjoining at least two bone fragments that includes providing a devicefor adjoining at least two bone fragments, the device including aconformable bone plate engaged to a delivery catheter having anelongated shaft with a proximal end, a distal end, and a longitudinalaxis therebetween, wherein the conformable bone plate has at least oneaperture extending from a first surface of the bone plate to a secondsurface of the bone plate for receiving a fastener to affix the boneplate to the at least two bone fragments; positioning the conformablebone plate over an exterior surface spanning the at least two bonefragments; attaching a delivery system housing at least one fillingmaterial to the delivery catheter, wherein the elongated shaft of thedelivery catheter has an inner void for passage of the at least onefilling material to the conformable bone plate; inserting a light sourceinto the delivery catheter, wherein the elongated shaft of the deliverycatheter has an inner lumen for passage of the light source to theconformable bone plate; infusing the at least one filling materialthrough the elongated shaft of the delivery catheter and into theconformable bone plate to expand the conformable bone plate; activatingthe light source to harden the at least one filling material in theexpanded conformable bone plate; releasing the hardened conformable boneplate from the delivery catheter; and affixing the conformable boneplate to the exterior surfaces of the at least two bone fragments toadjoin the bone fragments.

BRIEF DESCRIPTION OF THE DRAWINGS

The presently disclosed embodiments will be further explained withreference to the attached drawings, wherein like structures are referredto by like numerals throughout the several views. The drawings shown arenot necessarily to scale, with emphasis instead generally being placedupon illustrating the principles of the presently disclosed embodiments.

FIG. 1A and FIG. 1B show perspective views of a device for repairing acraniomaxillofacial injury of the presently disclosed embodiments. FIG.1A shows a conformable bone plate of the device in a deflated state.FIG. 1B shows a conformable bone plate of the device in an inflatedstate.

FIG. 2 shows an enlarged perspective view of the conformable bone plateof the device in an inflated state.

FIG. 3A, FIG. 3B and FIG. 3C show close-up views of some of the maincomponents of a device for repairing a craniomaxillofacial injury of thepresently disclosed embodiments. FIG. 3A shows a perspective view of adistal end of the device. FIG. 3B shows a side cross-sectional viewtaken along line A-A in FIG. 3A of the device. FIG. 3C shows across-sectional view of the device taken along line B-B in FIG. 3A.

FIG. 4 shows a perspective view of a light source for use with a devicefor repairing a craniomaxillofacial injury of the presently disclosedembodiments.

FIG. 5A and FIG. 5B show close-up cross-sectional views of some of themain components, including a light pipe, of the device for repairing acraniomaxillofacial injury of the presently disclosed embodiments. FIG.5A shows a side cross-sectional view of the device taken along line A-Afrom FIG. 3A. FIG. 5B shows a cross-sectional view of the device takenalong line B-B from FIG. 3A.

FIG. 6 shows the placement of a conformable bone plate of the presentlydisclosed embodiments during repair of a craniomaxillofacial injury.

While the above-identified drawings set forth presently disclosedembodiments, other embodiments are also contemplated, as noted in thediscussion. This disclosure presents illustrative embodiments by way ofrepresentation and not limitation. Numerous other modifications andembodiments may be devised by those skilled in the art which fall withinthe scope and spirit of the principles of the presently disclosedembodiments.

DETAILED DESCRIPTION

Medical devices and methods for repairing maxillofacial and craniofacialinjuries are disclosed herein. The craniomaxillofacial bone plates ofthe presently disclosed embodiments are made from a pliable, resilient,conformable, biocompatible, and strong material. At least one fillingmaterial is contained within the bone plates of the presently disclosedembodiments. During a procedure for repairing a craniomaxillofacialinjury, a conformable bone plate is brought to the site of injury (anosteotomy, a fracture, a bone graft or other site of injury) in adeflated state. Once in place, the bone plate is expanded from adeflated state to an inflated state in situ by the addition of the atleast one filling material. The addition of the at least one fillingmaterial may be precisely controlled such that the bone plate willresemble the contour of the site, on a patient-by-patient basis. Oncethe desired level of expansion is achieved, the at least one fillingmaterial is hardened within the bone plate using a light source. Thehardened bone plate is then affixed to the site using fasteners. Thecustomizable bone plate of the presently disclosed embodiments providessupport and proper orientation of the bony defect resulting in therepair, healing, and strengthening of the defect.

Filling materials include, but are not limited to, bone reinforcingmixtures (such as bone cement mixtures, bone void fillers, epoxies,glues and similar adhesives), orthopedic wires, stainless-steel rods,metal pins, and other similar devices. The filling material may be anatural or synthetic material for strengthening, replacing, orreinforcing of bones or bone tissue. Bone reinforcing mixtures includeglues, epoxies, adhesives, cements, hard tissue replacement polymers,biodegradable polymers such as PLA, PGA, and PLA-PGA copolymers, naturalcoral, hydroxyapatite, beta-tricalcium phosphate, and various otherbiomaterials known in the art for strengthening, replacing orreinforcing bones. As inert materials, bone reinforcing mixtures may beincorporated into surrounding tissue or gradually replaced by originaltissue. Those skilled in the art will recognize that numerous bonereinforcing mixtures known in the art are within the spirit and scope ofthe presently disclosed embodiments.

A device disclosed herein may be used for the repair of acraniomaxillofacial bony defect related to trauma, tumors, as well asfor developmental and congenital craniomaxillofacial deformities.

The main components of a device for repairing a craniomaxillofacial bonydefect are shown generally in FIG. 1A and FIG. 1B in conjunction withFIG. 2. The device 100 includes a delivery catheter 110 having anelongated shaft with a proximal end 102, a distal end 104, and alongitudinal axis therebetween. In an embodiment, the delivery catheter110 has a diameter of about 3 mm. The distal end 104 of the deliverycatheter 110 terminates in a releasable conformable bone plate 103. Thebone plate 103 may move from a deflated state (FIG. 1A) to an inflatedstate (FIG. 1B) when at least one filling material is delivered to thebone plate 103. In an embodiment, the thickness of the deflatedconformable bone plate 103 is about 7 mm. An inflated conformable boneplate 103, as shown in FIG. 1B, may have a size of about 3 mm by about10 mm. Alternately, the inflated conformable bone plate 103 may have asize of about 25 mm by about 25 mm. Those skilled in the art willrecognize that variations within these ranges are possible and stillwithin the scope and spirit of the presently disclosed embodiments. Thefilling material is delivered to the bone plate 103 via an inner voidcapable of allowing the filling material to pass through. In anembodiment, the filling material is a UV-activated glue.

A stiffening member 105 may surround the elongated shaft of the deliverycatheter 110 and provides rigidity over the elongated shaft. A pusher orstabilizer 116 is loaded proximal to the bone plate 103. A slip sleeve107 may surround the stiffening member 105. In an embodiment, the slipsleeve 107 surrounds the stiffening member 105 from a proximal end 123of the bone plate 103 up until the pusher 116. One or more radiopaquemarkers or bands 130 may be placed at various locations along the boneplate 103 and/or the slip sleeve 107 for alignment of the device 100during fluoroscopy or other forms of visualization. The one or moreradiopaque bands 130, using radiopaque materials such as barium sulfate,tantalum, or other materials known to increase radiopacity, allows amedical professional to view the device 100 using fluoroscopytechniques. The one or more radiopaque bands 130 also provide visibilityduring inflation of the bone plate 103 to determine the precisepositioning of the bone plate 103 and the device 100 during placementand inflation. The one or more radiopaque bands 130 permit visualizationof any voids that may be created by air that gets entrapped in the boneplate 103. The one or more radiopaque bands 130 permit visualization topreclude the bone plate 103 from misengaging or not meeting the bonydefects due to improper inflation. It may be desirable to imbedradiopaque beads on the corners of the conformable bone plate 103 toassist in the visualization/location of the bone plate 103.

In an embodiment, an adapter 115, such as a Tuohy-Borst adapter, engagesthe proximal end 102 of the delivery catheter 110. A light source thatincludes a light pipe 152 may be introduced into one of the side-arms ofthe adapter 115 and passes within an inner lumen of the deliverycatheter 110 up until the distal end 104 of the delivery catheter 110. Adelivery system 160 housing the filling material may be introduced intoanother side-arm of the adapter 115, as shown in FIG. 1A. Alternately, aLuer fitting may engage the proximal end 102 of the delivery catheter110 and a Luer fitting would exist on the light source such that thedelivery catheter 110 and the light source would lock together.

Examples of delivery systems include, but are not limited to, caulkinggun type systems, syringe systems, bag systems that contain the fillingmaterial where the delivery of the filling material is controlled usinga tube clamp or any other restrictor valve. In the embodiments shown inFIG. 1A and FIG. 1B, the delivery system 160 is a syringe. In anembodiment, the syringe 160 has a control mechanism that regulates theflow of the filling material. The control mechanism of the syringe 160allows the filling material to flow into the delivery catheter 110 andthe flow may be stopped if desired. The syringe 160 makes direct contactto control the directional flow of the filling material, and thedirection of flow of the filling material instantaneously changes withinthe delivery catheter 110 in response to a change in the direction ofthe syringe 160.

In an embodiment, the syringe 160 is opaque and does not allow light topenetrate within the syringe 160. Having an opaque syringe 160 ensuresthat the filling material contained in the syringe 160 is not exposed tolight and will not cure in the syringe 160. The filling material is of aliquid consistency, as measured in Centipoise (cP), the unit of dynamicviscosity, so the filling material may be infused from the syringe 160into the delivery catheter 110 and into the bone plate 103. Because thefilling material has a liquid consistency and is viscous, the fillingmaterial may be delivered using low pressure delivery and high pressuredelivery is not required, but may be used.

In an embodiment, a separation area is located at the junction betweenthe proximal end 123 of the bone plate 103 and the delivery catheter110. The separation area may also include an illumination band. Whenactivated, the illumination band causes light to cure the fillingmaterial located in the bone plate 103 within the illumination band. Theillumination band extends around the delivery catheter 110 and has astress concentrator. The stress concentrator may be a notch, groove,channel or similar structure that concentrates stress in theillumination band. The stress concentrator of the illumination band maybe notched, scored, indented, pre-weakened or pre-stressed to directseparation of the bone plate 103 from the elongated shaft of thedelivery catheter 110 under specific torsional load. The separation areaensures that there are no leaks of filling material from the elongatedshaft of the delivery catheter 110 and/or the bone plate 103. Theseparation area seals the bone plate 103 and removes the elongated shaftof the delivery catheter 110 by making a break at a known orpredetermined site (e.g., a separation area). The separation area may bevarious lengths and up to about an inch long. When torque (twisting) isapplied to the delivery catheter 110, the elongated shaft separates fromthe bone plate 103. The twisting creates a sufficient shear to break theresidual filling material and create a clean separation of theplate/shaft interface. The illumination band may be connected to thelight source and may be activated by a separate switch. Having adistinct switch to activate the illumination band may help to preventinadvertent delivery of light from the light source to cure the fillingmaterial. The activation of the illumination band seals the bone plate103 and seals the end of the delivery catheter 110, and ensures thatthere is a “hard seal” of the filling material at the illumination bandallowing no filling material to leak from the bone plate 103 or thedelivery catheter 110.

FIG. 2 shows a close-up view of the bone plate 103. The bone plate 103is a pad having, a first surface 133, a second surface 143, a right sidesurface 145, a left side surface 142, a front surface 141, a backsurface 144, and an inner space therebetween. The first surface 133 andthe second surface 143 each have a first area. The left side surface 142and the right side surface 145 each have a second area. The frontsurface 141 and the back surface 144 each have a third area. The firstarea is greater than the second area. A major longitudinal axis runsfrom the left side surface 142 to the right side surface 145, and aminor longitudinal axis runs from the first surface 133 to the secondsurface 143. The pad includes an opening 147 positioned only through theright side surface 145 of the pad, wherein the opening 147 issufficiently designed to engage the delivery catheter 110. At least onepre-punched aperture 121 extends from the first surface 133 to thesecond surface 143, along the minor longitudinal axis, for attaching thebone plate 103 to an exterior surface of the bone fragments. In theembodiment depicted in FIG. 2, there are five pre-punched apertures 121for attaching the bone plate 103 to the bone fragments, one aperture ateach corner and one aperture in the middle. This arrangement ofapertures 121 permits multiple connections to bones and ensurescontouring and consistent engagement to bones. Those skilled in the artwill recognize that the number and placement of the pre-punchedapertures 121 on the bone plate 103 may vary and still be within thescope and spirit of the presently disclosed embodiments. The apertures121 may be threaded or simply formed as non-threaded through holes. Theapertures 121 are adapted to receive a fastener for interconnecting thebone plate 103 with a severed bone region. In an embodiment, the boneplate 103 may have a baffle structure which reduces wave motion of thefilling material in the bone plate 103. Baffles would float within thebone plate 103 and may have serpentine, cone, coil or cylindricalshapes.

In an embodiment, the bone plate 103 may have a pre-defined shape to fitover a specific bony defect site. The bone plate 103 may be a pad thatis round, flat, cylindrical, oval, rectangular or another shape, as longas the bone plate 103 bridges and supports fragments of fractured bone.For example, as depicted in the embodiment of FIG. 2, the pre-definedshape of the bone plate 103 is a generally square pad.

The bone plate 103 may be formed of a pliable, resilient, conformable,biocompatible, and strong material, including but not limited tourethane, polyethylene terephthalate (PET), nylon elastomer and othersimilar polymers. In an embodiment, the bone plate 103 is constructedout of a PET nylon aramet or other non-consumable materials. PET is athermoplastic polymer resin of the polyester family that is used insynthetic fibers. Depending on its processing and thermal history, PETmay exist both as an amorphous and as a semi-crystalline material.Semi-crystalline PET has good strength, ductility, stiffness andhardness. Amorphous PET has better ductility, but less stiffness andhardness. PET can be semi-rigid to rigid, depending on its thickness,and is very lightweight. PET is strong and impact-resistant, naturallycolorless and transparent and has good resistance to mineral oils,solvents and acids.

The bone plate 103 has an outer surface 122. The outer surface 122 isresilient and puncture resistant. In an embodiment, the outer surface122 of the bone plate 103 is substantially even and smooth. In anembodiment, the outer surface 122 of the bone plate 103 is not entirelysmooth and may have some small bumps or convexity/concavity along thelength. In an embodiment, the outer surface 122 of the bone plate 103may have ribs, ridges, bumps or other shapes to help the bone plate 103conform to the shape of a bony defect. In an embodiment, the bone plate103 has a textured surface which provides one or more ridges that allowgrabbing all portions of bony defects. In an embodiment, sand blastedsurfacing on the outer surface 122 of the bone plate 103 improves theconnection and adhesion between the outer surface 122 of the bone plate103 and the bony defect. The surfacing significantly increases theamount of surface area that comes in contact with the bone resulting ina stronger grip.

The outer surface 122 of the bone plate 103 may be coated with materialssuch as drugs, bone glue, proteins, growth factors, or other coatings.For example, after a surgical procedure an infection may develop in apatient, requiring the patient to undergo antibiotic treatment. Anantibiotic drug may be added to the outer surface 122 of the bone plate103 to prevent or combat a possible infection. Proteins, such as, forexample, the bone morphogenic protein or other growth factors have beenshown to induce the formation of cartilage and bone. A growth factor maybe added to the outer surface 122 of the bone plate 103 to help inducethe formation of new bone. Due to the lack of thermal egress of thefilling material in the bone plate 103, the effectiveness and stabilityof the coating is maintained. In an embodiment, a water soluble glue isapplied to the outer surface 122 of the bone plate 103. When the boneplate 103 is expanded and engages a moist bone, the water soluble glueon the outer surface 122 of the bone plate 103 becomes sticky or tackyand acts as a gripping member to increase the conformal bond of the boneplate 103 to the bone. Once the bone plate 103 is inflated, the outersurface 122 of the bone plate 103 grips the bone forming a mechanicalbond as well as a chemical bond. These bonds prevent the potential for abone slippage. The water soluble glue may be cured by any light (e.g.,UV not required).

The bone plate 103 of the device 100 typically does not have any valves.One benefit of having no valves is that the bone plate 103 may beinflated or deflated as much as necessary to resemble the contour of thenew anatomy of an osteotomy, fracture or bone graft site. Anotherbenefit of the bone plate 103 having no valves is the efficacy andsafety of the device 100. Since there is no communication passage offilling material to the body there cannot be any leakage of materialbecause all the material is contained within the bone plate 103. In anembodiment, a permanent seal is created between the bone plate 103 thatis both hardened and affixed prior to the delivery catheter 110 beingremoved. In an embodiment, a permanent seal is created between the boneplate 103 that is hardened, the deliver catheter 119 is removed, and thebone plate 103 is affixed to the bone. The bone plate 103 may havevalves, as all of the embodiments are not intended to be limited in thismanner.

FIG. 3A, FIG. 3B and FIG. 3C show close-up views of some of the maincomponents of the device 100. One or more radiopaque markers or bands130 may be placed at various locations along the slip sleeve 107 of thedevice 100. Those skilled in the art will recognize that radiopaquemarkers 130 may also be placed at various locations along the bone plate103. In an embodiment, the one or more radiopaque bands 130 are placedat intervals of about 10 mm along the length of the slip sleeve 107. Theradiopaque markers 130 are formed using radiopaque material such asbarium sulfate, tantalum, or other materials known to increaseradiopacity. The radiopaque markers 130 provide visibility duringinflation of the bone plate 103 to determine the precise positioning ofthe bone plate 103 and the delivery catheter during placement andinflation. The radiopaque markers 130 permit visualization of voidscreated by air that may be entrapped in the bone plate 103. Theradiopaque markers 130 permit visualization to preclude the bone plate103 from misengaging or not meeting the bony defects due to improperinflation.

Once the correct positioning of the bone plate 103 and delivery catheterare determined, the proximal end of the delivery catheter may beattached to a delivery system that contains a filling mixture.

FIG. 3B shows a cross-sectional view taken along line A-A of FIG. 3A. Asshown in FIG. 3B, an elongated shaft 101 of the delivery catheterterminates in the bone plate 103 having the outer surface 122. Withinthe elongated shaft 101 of the delivery catheter 110 is a light pipeconduit 111 for accepting a light source (not shown). A void 113 forpassage of at least one filling material is formed between an innersurface 124 of the delivery catheter and an outer surface 117 of thelight pipe conduit 111. A delivery system comprising the at least onefilling material may be attached to a side arm of a Tuohy-Borst adapterthat is engaged to a proximal end of the delivery catheter. The at leastone filling material passes through the void 113 of the deliverycatheter and enters the bone plate 103. The infusion of the fillingmaterial causes the bone plate 103 to inflate to a desired state. In anembodiment, the filling material is infused through the void 113 in thedelivery catheter to expand the bone plate 103 such that the bone plate103 will resemble the contour of the new anatomy of an osteotomy,fracture or bone graft site. Orientation of the bones and bone plate 103may be done without any visualization of the process or using x-ray or afluoroscope. In an embodiment, a C arm imaging system is used as part ofa fluoroscope. The C arm imaging system may allow movement ormanipulation of the fluoroscope to rotate around tissue while viewing.Other techniques may be used for monitoring or inspecting the expansionof the bone plate 103 such as magnetic resonance imaging (MRI),ultrasound imaging, x-ray fluoroscopy, Fourier transform infraredspectroscopy, ultraviolet or visible spectroscopy. The bone plate 103may be composed of non ferromagnetic materials and, thus, is compatiblewith MRI.

FIG. 3C shows a cross-sectional view taken along line B-B of FIG. 3A. Inthe embodiment shown in FIG. 3C, the outer slip sleeve has been removed.The stiffening member 105 surrounds and provides rigidity to theelongated shaft 101 of the delivery catheter 110. The light pipe conduit111 provides a space for a light source to pass through. The void 113 isformed between the outer surface 117 of the light pipe conduit 111 andthe inner surface 124 of the elongated shaft 101. This void 113 providesa passageway for the at least one filling material. The outer surface117 of the light pipe conduit 111 allows for a separation between thelight source and the filling material.

FIG. 4 in conjunction with FIGS. 1A and 1B, shows a light source 150 foruse with the device 100 of the presently disclosed embodiments. Thelight source 150 is used to harden the filling material that has beeninfused into the bone plate 103 through the delivery catheter 110.

The light source 150 includes a light pipe 152 which terminates in anoptical lens 154. Energy emitted from the light pipe 152 is projectedthrough the optical lens 154 and guided into the bone plate 103 of thedevice 100. The optical lens 154 may be convex, concave or planar. Theoptical lens 154 is curved to converge or diverge the transmitted energyfrom the light pipe 152. In an embodiment, the optical lens 154 is madeout of a plastic material such as Acrylic (PMMA), Polycarbonate (PC),Polystyrene (PS), or other similar materials known to those in the artsuch as Cyclic Olefin Copolymer (COC), and Amorphous Polyolefin(Zeonex). In an embodiment, the optical lens 154 is made out of a glassmaterial such as quartz.

The light source 150 is introduced into a side arm of the adapter 115that engages the proximal end 102 of the delivery catheter 110, as shownin FIG. 1A. The light source 150 runs through the elongated shaft 101 ofthe delivery catheter 110 through the light pipe conduit and up into theproximal end 123 of the bone plate 103A. The activation of the lightsource 150 cures the filling material resulting in the affixing of thebone plate 103 in an expanded shape. A cure may refer to any chemical,physical, and/or mechanical transformation that allows a composition toprogress from a form (e.g., flowable form) that allows it to bedelivered through the void in the delivery catheter 110, into a morepermanent (e.g., cured) form for final use in vivo. For example,“curable” may refer to uncured composition, having the potential to becured in vivo (as by catalysis or the application of a suitable energysource), as well as to a composition in the process of curing (e.g., acomposition formed at the time of delivery by the concurrent mixing of aplurality of composition components).

In an embodiment, the filling material is a light cure adhesive orultraviolet (UV) adhesive. A benefit of UV curing is that it is acure-on-demand process and that adhesives may be free of solvents andinclude environmentally friendly resins that cure in seconds uponexposure to long wave UV light or visible light. Different UV adhesivesuse photoinitiators sensitive to different ranges of UV and visiblelight. Being very energetic, UV light can break chemical bonds, makingmolecules unusually reactive or ionizing them, in general changing theirmutual behavior. Visible light, for example, visible blue light, allowsmaterials to be cured between substrates that block UV light buttransmits visible light (e.g., plastics). Visible light penetratesthrough the adhesive to a greater depth. Since the visible lightpenetrates through the adhesive, curing of the adhesive increases as agreater portion of the electromagnetic spectrum is available as usefulenergy. Additives may be used with the UV adhesive delivery system,including, but not limited to drugs (for example, antibiotics), proteins(for example, growth factors) or other natural or synthetic additives.

The electromagnetic spectrum is the range of all possibleelectromagnetic radiation. The electromagnetic spectrum of an object isthe frequency range of electromagnetic radiation that the object emits,reflects, or transmits. The electromagnetic spectrum extends from justbelow the frequencies used for modern radio (at the long-wavelength end)to gamma radiation (at the short-wavelength end), covering wavelengthsfrom thousands of kilometers down to fractions of the size of an atom.In an embodiment, the UV adhesive is a single-component, solvent-freeadhesive that will not cure until a UV light engages the adhesive, andwhen that occurs, the adhesive will cure in seconds to form a completebond with a shear strength. In an embodiment, the filling materialexhibits a shrinkage upon cure of about 2 to about 3 percent.

UV light wavelength ranges from about 1 nm to about 380 nm, and can besubdivided into the following categories: near UV (380-200 nmwavelength; abbreviated NUV), far or vacuum UV (200-10 nm; abbreviatedFUV or VUV), and extreme UV (1-31 nm; abbreviated EUV or XUV).Similarly, visible light has a wavelength spectrum of between about 380to about 780 nm. Those skilled in the art will recognize that some UVadhesives may be activated by UV light, visible light, x-rays, gammarays, microwaves, radio waves, long waves or any light having awavelength less than about 1 nm, between about 1 nm and about 380 nm,between about 380 nm and about 780 nm, or greater than 780 nm, as notall embodiments are intended to be limited in that respect.

Using a UV light to cure the filling material assists in holding brokenbones in place, filling of the bone plate, and viewing under a C armimaging system. The filling materials cure in such a way that issufficient to conform to the contour of a bony defect. Morespecifically, the ability to inflate, set, adjust, orient bones, and theresulting union of the bone are available prior to hardening the fillingmaterial. The introduction of the UV light starts the photoinitiator andthe UV adhesive hardens. Once the UV light is introduced, the adhesiveinside the bone plate hardens and the adhesives inside are affixed inplace. Until the UV light is introduced, the bone placement is notdisturbed or rushed as there is no hardening of the adhesives until thelight is introduced, the bone plate may be inflated or deflated due tothe viscosity of the adhesive. The adhesive may be infused or removedfrom the bone plate due to the low viscosity of the adhesive. In anembodiment, the viscosity of the filling material has a viscosity ofabout 1000 cP or less. In an embodiment, the filling material has aviscosity ranging from about 650 cP to about 450 cP. Not all embodimentsare intended to be limited in this respect and some embodiments mayinclude filling materials having a viscosity exactly equal to or greaterthan 1000 cP. In an embodiment, a contrast material may be added to thefilling material without significantly increasing the viscosity.Contrast materials include, but are not limited to, barium sulfate,tantalum, or other contrast materials known in the art.

Several epoxies known in the art are suitable for use as fillingmaterials and vary in viscosity, cure times, and hardness (durometer orshore) when fully cured. A durometer of a material indicates thehardness of the material, defined as the material's resistance topermanent indentation. Depending on the amount of resultant support thatis necessary for a given bony defect, a specific durometer UV adhesivemay be chosen. Alternately, multiple UV adhesives having varyingdurometers may be chosen for the repair of a bony defect and be withinthe scope and spirit of the presently disclosed embodiments. Thedurometer of a material may be altered to achieve either greaterrigidity or a more malleable result. The mechanical properties of theepoxies may dictate using methods/measures that are typical forhigh-strength and high-impact materials including but not limited to,tensile strength and tensile modulus, tensile strength tests, ultimatemodulus, Poisson's ratio, hardness measurements like Vickers and CharpyImpact which measures yield strength and toughness.

In an embodiment, the filling material is cured by chemical activationor thermal activation. Chemical activation includes but is not limitedto water or other liquids. In an embodiment, the filling material is adrying adhesive which has a polymer dissolved in a solvent such that asthe solvent evaporates, the adhesive hardens. In an embodiment, thefilling material is a hot or thermoplastic adhesive such that as theadhesive cools, the adhesive hardens.

Some filling materials may require or be enhanced by curing via anymeans, such as UV or visible light, heat, and/or addition or removal ofa chemical or substance, may utilize any outside or internal processesto cure the material, or may not require curing.

In an embodiment, carbon nanotubes (CNTs) are added to the fillingmaterial to increase the strength of the material. Carbon nanotubes arean allotrope of carbon that take the form of cylindrical carbonmolecules and have novel strength properties. Carbon nanotubes exhibitextraordinary strength. Nanotubes are members of the fullerenestructural family, which also includes buckyballs. Whereas buckyballsare spherical in shape, a nanotube is cylindrical with at least one endtypically capped with a hemisphere of the buckyball structure. Nanotubesare composed entirely of sp2 bonds, similar to those of graphite. Thisbonding structure, which is stronger than the sp3 bonds found indiamond, provides the molecules with their unique strength. Nanotubesnaturally align themselves into “ropes” held together by Van der Waalsforces. Single walled nanotubes or multi-walled nanotubes may be used tostrengthen the filling materials.

In an embodiment, a central space may remain in the bone plate 103 whichmay be filled in order to provide extra strength and support to thefractured bones. An optical rod or similar device may be positioned inthe central space and turned on or illuminated. An optical rod orsimilar device can be made of fiber, silica, quartz, sapphire or similarmaterials. The end of the optical rod may be cut and remain in the boneplate 103 to provide increased rigidity.

FIG. 5A and FIG. 5B show cross-sectional views of the device 100 of FIG.1A, showing the light source 150 of FIG. 4 passing through the lightpipe conduit 111 of the delivery catheter 110, through the opening 147and into the inner space of the pad along the longitudinal axis of thepad. The light source includes the light pipe 152 terminating in theoptical lens 154. The light source is used to harden the fillingmaterial that has been infused into the bone plate 103 of the device100. Energy from the light source 150 is emitted from the light pipe152, projected through the optical lens 154, and guided into the boneplate 103 of the device 100. The optical lens 154 may be convex, concaveor planar. The optical lens 154 is curved to converge or diverge thetransmitted energy from the light pipe 152.

Millions of people sustain trauma to the head and face resulting incomplex fractures which, if not correctly diagnosed and treated, maycause permanent functional and cosmetic deformities. In acute traumacases, the goal of reconstruction is a one-stage repair which has beenmade possible by the application of craniofacial techniques. Delayedtreatment has been replaced by early or immediate surgical treatment andstabilization of small bone fragments augmented by bone grafts andminiplate fixation. These recent advances have allowed surgeons toapproach and often reach the goal of restoring preinjury facialappearance and function while at the same time minimizing revisionalsurgery. Without treatment in a timely manner, many individuals willdevelop future problems, the severity and consequences of which can bemuch greater than if the injury had been immediately repaired.Craniofacial surgery encompasses the reconstruction of a broad spectrumof facial deformities including, but not limited to, zygomaticfractures, maxillary fractures, nasoethmoid orbital fractures, internalorbital fractures, mandibular fractures, post-traumatic facialdeformities, soft tissue deformities, and facial bone contouring. Animplant for fracture fixation must be strong, ductile, adaptable to thebone surface and biocompatible. Fixation system quality includesadequate strength and rigidity, avoiding adverse reactions, interferencewith bone healing, intracranial migration, visibility and palpabilityand implant removal operation.

FIG. 6 illustrates the device 100 of the presently disclosed embodimentsin use during a procedure for repairing a craniomaxillofacial bonydefect in a patient. The procedure begins with placing the deflated boneplate 103 of the device 100 at the bony defect, where the bone plate 103spans at least two bone fragments (A and B in FIG. 6). A deliverysystem, such as the syringe 160 filled with the filling material (notshown), is attached to the device 100. The filling material is theninfused through the inner void in the elongated shaft of the deliverycatheter 110 and enters the bone plate 103 of the device 100, causingthe bone plate 103 to move from a deflated state to an expanded state.Once the bone plate 103 has been expanded to a desired level (which iscontrolled by a medical professional with the syringe 160), andorientation of the bone fragments are confirmed to be in a desiredposition, the light source 152 is attached to the device 100. The lightsource 152 is passed through the elongated shaft of the deliverycatheter 110 through the light pipe conduit. In an embodiment, thefilling material is a UV curable glue which requires a UV light sourceto cure the adhesive. The light source 152 is then activated whichcauses the filling material to harden. The hardened bone plate 103 maybe affixed to the bony defect site, thus stabilizing the fracture. Thelight source 152 is removed from the device 100 and the bone plate 103is released from the delivery catheter 110. In an embodiment, thedelivery catheter 110 is cut to separate the bone plate 103 from theelongated shaft 101. A device slides over the delivery catheter 110 andallows a right angle scissor to descend through the delivery catheter110 and make a cut. The location of the cut may be determined by using afluoroscope or an x-ray. In an embodiment, the cut location is at thejunction where the elongated shaft 101 meets the bone plate 103.

In an embodiment, a separation area is located at the junction betweenthe proximal end 123 of the bone plate 103 and the delivery catheter110. The separation area may also include an illumination band. Whenactivated, the illumination band causes light to cure the fillingmaterial located in the bone plate 103 within the illumination band. Theillumination band extends around the delivery catheter 110 and has astress concentrator. The stress concentrator may be a notch, groove,channel or similar structure that concentrates stress in theillumination band. The stress concentrator of the illumination band maybe notched, scored, indented, pre-weakened or pre-stressed to directseparation of the bone plate 103 from the elongated shaft of thedelivery catheter 110 under specific torsional load. The separation areaensures that there are no leaks of filling material from the elongatedshaft of the delivery catheter 110 and/or the bone plate 103. Theseparation area seals the bone plate 103 and removes the elongated shaftof the delivery catheter 110 by making a break at a known orpredetermined site (e.g., a separation area). The separation area may bevarious lengths and up to about an inch long. When torque (twisting) isapplied to the delivery catheter 110, the elongated shaft separates fromthe bone plate 103. The twisting creates a sufficient shear to break theresidual filling material and create a clean separation of theplate/shaft interface. The illumination band may be connected to thelight source and may be activated by a separate switch. Having adistinct switch to activate the illumination band may help to preventinadvertent delivery of light from the light source to cure the fillingmaterial. The activation of the illumination band seals the bone plate103 and seals the end of the delivery catheter 110, and ensures thatthere is a “hard seal” of the filling material at the illumination bandallowing no filling material to leak from the bone plate 103 or thedelivery catheter 110.

The bone plate 103 may be fastened to the bony defect before, after orduring a repair procedure. Fasteners 163 are disposed through theapertures 121 and engage the bone plate 103 to secure the bone plate 103to one or more portions of bone.

A method for adjoining at least two bone fragments includes providing adevice for adjoining at least two bone fragments, the device including aconformable bone plate engaged to a delivery catheter having anelongated shaft with a proximal end, a distal end, and a longitudinalaxis therebetween, wherein the conformable bone plate has at least oneaperture extending from a first surface of the bone plate to a secondsurface of the bone plate for receiving a fastener to affix the boneplate to the at least two bone fragments; positioning the conformablebone plate over an exterior surface spanning the at least two bonefragments; attaching a delivery system housing at least one fillingmaterial to the delivery catheter, wherein the elongated shaft of thedelivery catheter has an inner void for passage of the at least onefilling material to the conformable bone plate; inserting a light sourceinto the delivery catheter, wherein the elongated shaft of the deliverycatheter has an inner lumen for passage of the light source to theconformable bone plate; infusing the at least one filling materialthrough the elongated shaft of the delivery catheter and into theconformable bone plate to expand the conformable bone plate; activatingthe light source to harden the at least one filling material in theexpanded conformable bone plate; releasing the hardened conformable boneplate from the delivery catheter; and affixing the conformable boneplate to the exterior surfaces of the at least two bone fragments toadjoin the bone fragments. In an embodiment, the at least two bonefragments are bones of the face. In an embodiment, the light source isremoved from the delivery catheter once the at least one fillingmaterial has been hardened.

The bone plates and devices disclosed herein have been discussed in therepair of a craniomaxillofacial bony defect. Those skilled in the artwill recognize that the bone plates and devices may be used in a varietyof areas, such as bones of the vertebrae and any other fractured bonethat required support on its exterior surface so as to hold thedisassociated portions in alignment during healing.

All patents, patent applications, and published references cited hereinare hereby incorporated by reference in their entirety. It will beappreciated that various of the above-disclosed and other features andfunctions, or alternatives thereof, may be desirably combined into manyother different systems or applications. Various presently unforeseen orunanticipated alternatives, modifications, variations, or improvementstherein may be subsequently made by those skilled in the art which arealso intended to be encompassed by the following claims.

What is claimed is:
 1. A method for adjoining at least twocraniomaxillofacial bone fragments comprising: providing a conformablebone pad engaged to a delivery catheter having an elongated shaft with aproximal end, a distal end, and a longitudinal axis therebetween,wherein the conformable bone pad has at least one aperture extendingfrom a first surface of the conformable bone pad to a second surface ofthe conformable bone pad for receiving a fastener to affix the bone padto the at least two bone fragments; positioning the conformable bone padover an exterior surface of the at least two craniomaxillofacial bonefragments; attaching a delivery system having at least one fillingmaterial to the delivery catheter, wherein the elongated shaft of thedelivery catheter has an inner void for passage of the at least onefilling material to the conformable bone pad; inserting a light fiberinto the delivery catheter, wherein the elongated shaft of the deliverycatheter has an inner lumen for passage of the light fiber into theconformable bone pad; infusing the at least one filling material throughthe elongated shaft of the delivery catheter and into the conformablebone pad to expand the conformable bone pad; activating the light sourceto harden the at least one filling material in the expanded conformablebone pad; releasing the hardened conformable bone pad from the deliverycatheter; and affixing the conformable bone pad to the exterior surfacesof the at least two craniomaxillofacial bone fragments to adjoin thebone fragments.
 2. The method of claim 1 wherein the conformable bonepad includes a major longitudinal axis running from the proximal surfaceto the distal surface and a minor longitudinal axis running from thefirst bone contacting surface to the second outer surface andintersecting the major longitudinal axis at an intersection.
 3. Themethod of claim 2 wherein the at least one aperture includes at leastone centered through aperture extending from the second outer surface tothe first bone contacting surface through a center of the conformablebone pad and through the intersection of the minor longitudinal axis andthe major longitudinal axis of the conformable bone pad.
 4. The methodof claim 3 wherein the at least one aperture includes one or moreperipheral through apertures extending from the second outer surface tothe first bone contacting surface at a periphery of the conformable bonepad.
 5. The method of claim 1 further comprising contouring theconformable to engage against the at least two craniomaxillofacial bonefragments.
 6. The method of claim 1 wherein the at least two bonefragments are bones of the face.
 7. The method of claim 1 furthercomprising removing the light fiber from the delivery catheter after theat least one filling material has been hardened.
 8. The method of claim1 wherein the conformable bone pad is constructed from a polymermaterial.
 9. A method for repairing craniomaxillofacial bone fracturescomprising: providing a conformable bone pad releasably engaged to adelivery catheter having an elongated shaft with a proximal end, adistal end, and a longitudinal axis therebetween, wherein theconformable bone pad comprises: a first bone contacting surface and anopposing second outer surface, a left side surface and an opposing rightside surface extending between the first bone contacting surface and thesecond outer surface, and a proximal surface and an opposing distalsurface extending between the first bone contacting surface and thesecond outer surface defining an inner space in communication with aninner void of the delivery catheter for passage of at least one fillingmaterial into the inner space for expanding the expandable conformablebone pad; a major longitudinal axis running from the proximal surface tothe distal surface; a minor longitudinal axis running from the firstbone contacting surface to the second outer surface and intersecting themajor longitudinal axis at an intersection; an opening at the proximalsurface of the conformable bone pad to pass the at least one fillingmaterial into the inner space of the conformable bone pad; and at leastone aperture extending from the second outer surface to the first bonecontacting surface for receiving a fastener therethrough to affix thebone pad to at least two craniomaxillofacial bone fragments; engagingthe at least two craniomaxillofacial bone fragments with the conformablebone pad; expanding the conformable bone pad by infusing the at leastone filling material into the inner space through the inner void of thedelivery catheter; hardening the at least one filling material in theinner space of the expanded conformable bone pad; releasing the hardenedconformable bone pad from the delivery catheter; and affixing theconformable bone pad to the exterior surfaces of the at least twocraniomaxillofacial bone fragments with a fastener inserted into the atleast one aperture.
 10. The method of claim 9 wherein the at least oneaperture includes at least one centered through aperture extending fromthe second outer surface to the first bone contacting surface through acenter of the conformable bone pad and through the intersection of theminor longitudinal axis and the major longitudinal axis of theconformable bone.
 11. The method of claim 10 wherein the at least oneaperture includes one or more peripheral through apertures extendingfrom the second outer surface to the first bone contacting surface at aperiphery of the conformable bone pad.
 12. The method of claim 9 furthercomprising passing a light fiber into the inner space of the conformablebone pad through an inner lumen of the delivery catheter.
 13. The methodof claim 12 wherein the optical fiber is passed into the inner space ofthe conformable bone pad through the opening of the conformable bone padalong the major longitudinal axis of the conformable bone pad.
 14. Themethod of claim 9 further comprising transmitting light from a lightsource through a light fiber into the inner space for hardening the atleast one filling material in the inner space of the conformable bonepad.
 15. The method of claim 14 further comprising removing the lightfiber from the delivery catheter after at least one filling material hasbeen hardened.
 16. The method of claim 9 further comprising activating alight source to harden the at least one filling material.
 17. The methodof claim 9 further comprising contouring the conformable bone pad toengage against the at least two craniomaxillofacial bone fragments. 18.The method of claim 9 further comprising positioning the conformablebone pad over an exterior surface of the at least twocraniomaxillofacial bone fragments.
 19. The method of claim 9 whereinthe conformable bone pad is constructed from a polymer material.
 20. Themethod of claim 9 wherein the at least one filling material is a lightcurable glue.